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HomeMy WebLinkAbout1973DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 36.31 -1 -53 BOX 18 le 1. ko �` r ti� 01973 6� PUTNAM COUNTY DEPARTMENT OF HEALTH I2I�']GSIQN�O�' E1�VIRONMENTA .L- ;�I�A�LTH_ SERVICE S.: CERTIFICATE OF CONSTRUCTION COMPLIANCE FOR SEWAGE TREATMENT SYSTEM PCIII)CONSTRUCTION PERMIT # F-1?-0S Located lr Village -r Owner /Applicant Name _R P Dl< \lEr-opr e AT- l rl . Tax Map 3Co . 31 Block I Lot --3 Formerly ,%l+,3 t- <J ""mr —S Subdivision Name N1 Subd. Lot # t J /A Mailing Address 2 140 2 Z . Bfz c-W si-E R-- �11 . Zip Date Construction Permit Issued by PCHD 5 4!E; Separate Sewerage System built by f'� t= toPr- ��►.►-r , r,.l� Address 21 �I-o P-ar 22_.�s r�r�s Y Consisting of /®oo Gallon Septic Tank and f 2cl L. f O F 2 I L.9 i r>E Other Requirements: GLsAy I ov Water Supply: Public Supply From. Address ! ar 8 9-c"-M 3l I or: Private Supply Drilled byAi WCrA r-1, 4 gA.rr 4 SonIS Address Pp,-r- ry, -e-w J 65iiIiiL4 -Rost oiz:eHas erosion control-been - completedg Number of Bedrooms 3 Has garbage grinder been installed? t- � I certify that the system(s), as listed, serving the above premises were constructed essentially as shown on the as- built plans (copies of which are attached), in accordance with the issued PCHD Construction Permit and approved plans and the standards, rules and regulations of r ounty De ment of Health. Date: _ � o Certified by P.E.X R.A. (Design Professlonal) Address h,=,4Ajn w-c- o v 6 License # O&-I -++ G F- ewsreR / n1 Y, /a So Any person occupying premises served by the above system(s) shall promptly take such action as may be necessary to secure the correction of any unsanitary conditions resulting from such usage. Approval of the separate sewage treatment system shall become null and void as soon as a public sanitary sewer becomes available and the approval of the private water supply shall become null and void when a public water supply becomes available. Such approvals are subject to modification or change when, in the judgment of the Public Health Director, such revoc ion, modifica ' n or change is necessary. kUJW604 By: Title: Date: White copy - HD le; Ye-'l opy - Building Inspector; Pink copy - Owne , Orange copy - Design Professional Form CC -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES WELL COMPLETION REPORT Well Location ' " Street Address: "- - ` ' °' `' 6 " Tow' illage: se Tax Grid # Map Block Lot(s) Well Owner: Name: a C7 Address: eill Cc ia& � Use of Well: 1- primary 2- secondary Residen& Public Supply Air cond/heat pump Irrigation Business Farm Test/monitoring Other(specify) Industrial Institutional Standby Drilling Equipment Rotary Cable percussion Compressed air percussion Other (specify) Well Type Screened Open end casing X Open hole in bedrock Other Casing Details Total length ft. Length below grade Diameter Tin. Weight per foot jLlb /ft. Materials: - Steel iN Plastic _ Other Joints: _ Welded Threaded _ Other Seal: Cement grout _ Bentonite Other Drive shoe: ' Yes No Liner _ Yes No Screen Details Diameter (in) Slot Size Length(ft) Depth to Screen (ft) Developed? First Yes—No Hours Second Well Yield Test _ Bailed _ Pumped XCompressed Air Hours Yield glD gpm Depth Data Measure from land surface- static (specify ft) U During yield test(ft) /,e e, Depth of completed well in feet 365' Well Log If more detailed information descriptions or sieve analyses are available, please attach. Depth From Surface Water Bearing Well Diameter(in) Formation Description ft. ft. Land Surface 16 ' If yield was tested at different depths during drilling, list: Feet Gallons Per Minute Pump /Storage Tank Information Pump Type , Capacity Depth Model, Voltage HP a l Tank Type d *� -0 dVolume ��01- Date Well ompl ted 0 d Putnam County Certification No. 667 Date of eport 3 42./ 6d Well Driller (signature) I AII& %6& N01VE: E$act location of well with distances to at least two permangfit landf larks to be provided on a separat$Iteet/plan. Well Drillees Name c , b� A,$ Address: oil Signature: Date: Li White copy: HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WC -97 BRUCE R_ F_ OLEY Public Health Director LORETTA MOLINARI R.N., M.S.N. Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road Brewster, New York 10509 Environmental Health (914) I78 - 6130 Fax (914) 278 - 7921 Nursing Services (914) 278 - 6558 WIC (914) 278 - 6678 Fax (914) 278 - 6085 Early Intervention. (914) 278 - 6014 Preschool (914) 278 -6082 Fax (914) 278 - 6648 E911 ADDRESS VERIFICATION FORM OWNERS NAME: TAX MAP NUMBER: E911 ADDRESS: 3 y bo--G" '27 lad irej TOWN: AUTHORIZED TOWN OFFICIAL: (Signature) DATE: �/3 v O The Putnam County Department of Health will not issue a Certificate of Construction Compliance i�rless the above form is completed, i.e., a legal E911 address is assigned by an authorized town official. This form is to be submitted with the application for a Certificate of Construction Compliance. — (E911 VERFRK SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 June 15, 2006 ROBERT J. BONDI County Executive ROBERT MORRIS, PE. Director of Environmental Health Paul Lynch, PE Putnam Engineering 4 Old Route 6 Brewster, New York 10509 Re: Construction Compliance for RP Development @ 30 Danbury Road (T) Patterson, TM# 36.31 -1 -53 Dear Mr. Lynch: This Department has received and reviewed the submitted application and plans for the above referenced project and the following comments are offered for your consideration. 1/1. The submitted as-built plan shows the subject property with a different lot line configuration than the one on the approved construction permit plan. Please explain and clarify the discrepancy. /2. The existing well on the east side of Danbury Road is to be field located and not labeled as "approximate location." , 3•: The location- of the existing well to -the -north of the property is to be shown on the V1plan. 4. It does not appear the following water quality parameters were analyzed: nitrates, nitrites, manganese, sodium and turbidity. Upon completion of the above, this Department will continue its review. Kindly advise us if there are any questions. MJB:cj Respectfully, Michael J. Bu4zi Director of Akir Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 0 UTNAM NGINEERIN 7, PLLE Engineers and Architects June 20, 2006 Michael Budzinski, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: RP Development, Inc. Construction Compliance 30 Danbury Road Town of Patterson TM # 36.31 -1 -53 PCHD Permit #P -9 -03 Dear Mr. Budzinski, Putnam Engineering, PLLC is in receipt of your letter dated June 15, 2006 and has addressed your comments as follows: 1. The As -Built Plan has been revised to show the original property lines as shown on the approved SSTS Plan along with the current property line configuration of the parcel. As noted on the plan a lot line change was approved and recorded with Putnam County on filed map number 3000, filed on September 30, 2005. 2. The existing well on the eastside of Danbury Road has been located and the actual separation to the new SSTS has been noted. 3. The existing well to the north has been shown on the plan. 4. A new water analysis is attached including test results for all parameters as outlined in Putnam County Health Department Bulletin ST -19. Please contact me at this office if you have any questions or require any additional information. Sincerely, PUTNAM ENGINEERING, PLLC Richard J. r RJZ /ea (L06230) 4 VLD ROUTE 6, &REWSTER, NEW YORK 10509 • (845) 279 -6789 • FAx (845) 279 -6769 • EMAIL: info @putnameng.com YML ENVIRONMENTAL SERVICES 321 Kear Street 1.0.5 '..'.s^�~��r=��z��.��/�����-�-�' Albert H.'Padovani, Director LAB #: 9.600943 CLIENT #: 56271 NON STAT PFOC PAGE: 1 REILLY CONSTRUCTION DATE/TIME TAKEN: 06/20/06 03:30 2140 RT 22 DATE/TlME REC'D: 06/20/06 03:55 BREWSTER, NY 10509 REPORT DATE: 06/23/06 PHONE: (845)-278-4059 SAMPLING SITE: 30 DANBUPS ROAD SAMPLE TYPE..: POTABLE : WATER TANK PRESERVATIVES)- NONE COL'D @Y: TEMPERATURE..: NOTES ...: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ COLIFORM METH: N/A DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD 06/23y06 MANGANESE (Mn) <0.010 MG/L 0-0.3 mg/1 9002 06/23/06 SODIUM (Na) 9.06 MG/L N/A 9002 06/23/06 TURBIDITY (TUR <1 NTU 0-5 NTU 06/23y06 NITR#TE NJTROG 0.64 MG/L 0 - 10 9052 06/23/06 NITRITE NITROG <0.01 MG/L N/A 9162 06/23/06 ALKALINITY (AS 40.0 MG/L N/A 9001 COMMENTS: PICK UP IN CARMEL ' COMMENTS: Na No limits for Sodium are proscribed. Suggested guidelines state that for people on a sodium restricted diet,the water should contain no more than 20 mg/L. of Sodium. For.those on a moderately restricted diet, a maximum of 270 mg/L. of Sodium is suggested. SUBMITTED BY: ELAP# 10323 0 UTNAM NGINEERING, PLLE. Engineers and �Architects SEPTIC SUBMISSION FORM TO: r 1 l C�VA EL DATE: PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: VEYeLc>Pmr=tlT trlc-• iFucZt-exkL `f Ano" A 3.*.mE4 `�Eu•11+ A-��> ENCLOSED, PLEASE FIND: S COPIES OF THE SSDS "AS- BUILT" PLAN CONSTRUCTION COMPLIANCE CERTIFICATE WELL LOG l�J HEALTH DEPARTMENT FEE ($300.00) WATER ANALYSIS 0 GUARANTEE FORMS - 3 ORIGINALS 0 E 911 ADDRESS FORM ❑ LETTER OF EXPLANATION I ,. COPIES TO: (SepSubFom-2004) SIGNED: 12-kc 1 2A!Pp 4 OLD RouTE 6, BREW8TER, NEW YORK 10509 • (845) 279 -6789 • FAx (845) 279 -6769 • EMAlL: putnamengineering@rcn.com ' YML ENVIRONMENTAL SERVICES 321 Kear Street Yorktown Heights, N.Y. 5 ' - - ' -' Albert H. Paduvani, Director LAB #: 9.600775 CLIENT #: 59414 NON STAT PROC PAGE: 1 ---- m--Wm ----- M --------- M—m—m—m— M-Mmmmm --- —~m—M ------------------- ;41 REILLY CONSTRUCTION P.O. BOX 757 BREWSTER, NY 10509 DATE/TIME TAKEN: 05/30/06 12:15 DATE/TIME REC'D: 05/30/06 01:55 REPORT DATE: 06/06/06 PHONE: (845)-278-4059 SAMPLING SITE: 30 DANBURY ROAD SAMPLE TYPE..: POTABLE . : PATTERSON PRESERVATIVES: NONE COL'D 8Y: TOM BILLfN ' TEMPERATURE..: < 4C NOTES...: WATER TANK COLIFORM METH: MF -6 ---- m ---- --.. "--m ----- m— ---- .. ------------ .....�� DATE FLAG PROCEDURE RESULT NORMAL - RANGE METHOD BASIC PROFILE NMS 05/30/06 MF T. COLIFORM ABSENT /100 ML ABSENT 1008 06/06/06 COPPER (Cu) <0.050 MG/L 0-1.0 mg/l 9002 06/01/06 IRON (Fe) <8.060 MG/L 0-0.3 mg/1 ' 9002 06/05/06 TDS 78 MG/L N/A 9064 05/31/06 CONDUCTIVITY 123 umho/cm N/A 9071 06/05/06 HARDNESS, TOTAL 46.0 MG/L N/A 05/31/06 pH 7.2 UNlTS 6.5-(;.5 9043 06/05/06 LEAD (NMS) 11.0 pph 0-15 ppb 9003 COMMENTS: ~--1PICK- UP- IN CARMEL COMMENTS: BACT THESE RESULTS INDICATE THAT THE WATE WAS NOT) OF A SATISFACTORY SANITARY QUALITY ACCORD[p��J��;HE NEW YORK STATE AND EPA FEDERAL DRINKING WATER STANDARDS, FOR THE PARAMETERS TESTED, AT THE TIME OF COLLECTION. Fe/Mn If both iron and manganese are present, their total value combined shall not exceed 0.5 mg/L. TDS TDS IS A DIRECT MEASUREMENT OF CHEMICALS DISSOLVED IN WATER. WATER WITH HIGH D{SSOLVED'SOLlDS GENERALLY ARE OF INTERIOR PALATABILITY AND INDUCE AN UNFAVORABLE PHYSIOLOGICAL REACTION IN THE TRANSIENT CONSUMER. FOR THESE REASONS, A LIMIT OF 500 MG/L IS DESIRABLE FOR DRINKING WATER., Hd TOTAL HARDNESS IS DEFINED AS THE SUM OF THE CALCIUM & MAGNESIUM CONCENTRATION, BOTH EXPRESSED AS CALCIUM CARBONATE, IN MG/L. THE HARDNESS MAY RANGE FROM O TO HUNDREDS OF MG/L, DEPENDS ON THE SOURCE AND TREATMENT TO WHICH THE WATER HAS BEEN SUBJECTED. YML. ENIVIRONPIENTAL SERV i C:E S 321 Kear Street Yorktown Height:<.s,,, N.Y. 1.0598 AIber..t: Hn P aclovani.., 1iir-ec tor LAB #.- 9.,60077_5 CLIENT #: 59414 NON STAT PROC F AG)E:: 4 p RE:I I...1_.Y CONSTRUCTION P.O. BOX '757 F:JREWSTE::R, NY 10509 DA TE:: /TIME:: TAKEN: w 01,:`r / 0 /F: 6 12.113 DATA:: 'V I f °IFS: REC. ' D ° 05/,30/06 01,-53 REPORT DA'T'E:: .06/06/06 PHONE a ((3r+ 1-- 2'71:3•--4 :> 9 E3(- 1f`'IPL I N6 S I TE �. :30 DANDURY ROAD SAMPLE: TYPE,. ,. „ IaCI T'AE +LEA F FEE" FVAI I VE t a tCuLPATT =FSON COL.'D BY: TON BI:L_L.IN TEMPERATURE 4C NOTES. a e WATER TANK COL T f= ORM VIE: TH . VJF=. w ry l.f+.f wlvJ.fwwl.fJV rN ry rV+vwl.l+vM ... ... ... ... ..Jwlfl xv NJffN IH lV 1V IfI lfl tffwtta rH wwwwly rNwlaJJ!f M1v rN 1V rN Iffl.I.V He Iff<V..IIifJVlfflfl 1111!f.•flVtfl llf Jlf lf.•rV IV :1f lfl :!/+•.+ I ?ATE:: FLAG PROCEDURE RE'SUI...T NORMAL - -• RANGE METHOD SOFT WATER: 0­ 70 Mfg /L VERY HARI) WATER: ATNIVE 300 MB /!_ VIDDIERATELY HARD WATER: '7 0 ° 1 c {.c;> MC:i /L VIGIL = MILLIGRAM PER LITER HARI) WATER: 140--300 MG /L• (I grain /gal lon = 17:.2 Mf.* /L_ ) pH pH SCALE IN WATER RANGES FROM 1 --14. MEASUREMENT [)F pl °I IS ONE O :' THE U-11"ORT ANT AND FREQUENTLY USED TESTS YN WATER CHEMISTRY. WATE: Z WITH A LOW pl-I MIGHT BE" CORROSIVE:. TO METAL PIPES AND F I YT°URES,. THE'. NORMAL. RAN(3E OF I.-)H IS 6-.5 TO 8.5. Pb /Cu LEAD limits for p EPA Lead is: Copper than 10% of their - t;hitr.� .1.5 .ppb and .a treatment mL(St be potential. ab l is schools Are set at 15 ppb .. Rule for f'Llbli.0 SySt:emS requires that no more distribution points, have a LEAD va:1Lte of more COPPER va-l:ue' +_af 1,.'13 mg1I_.., Undertat %en to rer(iuc:e.� the water; rorrt,<.:,ive 3UBM I TTED BY Albert. H,. Padovan i.., M., Ta. (ASC;F•) Director F: L.AP # 10323 PUTNAM COUNTY DEPARTMENT OF HEALTH GUARANTEE OF SUBSURFACE SEWAGE TREATMENT SYSTEM !? r' ,�3/� ✓/�`al��h i•• T 36,31 1 S3 Owner or Purchaser of Building Tax Map Block Lot Building Constructed by TownNillage Location - Street Subdivision Name Building Type Subdivision Lot # I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of the sewage treatment system serving the above - described property, and that is has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage treatment system, or any repairs made by me to such system, except where the failure to operate..properly is caused by the willful or negligent act of the occupant of the. building utilizing the system. The undersigned further agrees to accept as conclusive the determination of -the Public Health Director of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated: Month -5' Da 3d Year o& Signature: Y � j2P /�F✓F�vp m F,v� %�� Title: General Contractor (Owner) - S4haturef Corporation Name (if corporation) Corporation Name (if corporation) Address: a /yo /2tO- J xwy-o z Address: State tVi Zip State Zip Form GS -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at 90 1).1N13"z7 121) T/V ,DArrK1061/v Tax Map # 36 • 3%- /- 53 Block Lot Subdivision of Subdivision Lot # Gentlemen: 7 Filed Map # ' Date Filed This letter is to authorize f;ui�N 6 / N /r Q�2 /!✓ J- a duly licensed Professional Engineer � or Registered Architect, to apply for the required wastewater treatment and/or water supply permit(s) to serve the above -noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater tretment and/or water supply systems in conformity with the provisions of Article 145 and/or 147 of the Education Law, the Public Health Law; and-- the?Putnam--County-Sanitary Code., - Very truly yours, Countersigned: Signed: P.E. R.A., # ®(o-1,*Zf wnerofProperty) Mailing Address P,,rjArn N�� Mailing Address: 22- State tj -/ Zip /oSoC� Telephone: _68 •2'19 - ('" ta9 ,6/1R w yi'F/Z State ^y Zip /$ 50 9 Telephone: if `/5 -) ) �- %s % Form LA -97 !! tl �� - �,. 1 11 ='AFFIDAVIT - CORPORATE OWNER APPLICATION FOR PERMIT APPLICATION SUBMITTED TO PUTNAM COUNTY HEALTH DEPARTMENT To: Public Health Director In the matter of application for: represent that I am an officer or employee of the corporation and am authorized to act for: Name of Corporation: /z/' AkvRa Having offices at: o?ry® /2TX. a Aar, -l`CR �,Y 10SO Whose Officers Are: President - Name Address: Vice President - Name: J ► s,t p� tax tl �Ly aL �/d 47-X a a. AQ& Aep- ^y Ja , iJ ,c iQIL_ CC) lg5a � Address: P, yr 12,,,7n a-2- g129wVr ,-t2 ^Z IVSO� Secretary -Name: %a M Address.- 6-b-/j 2 7r. a°Z ltwJIlj2 Treasurer - Name: 4 Address: and that I am and will be individually responsible for any and all acts of the corporation with respect to the approval requested and all subsequent acts relating thereto. Sworn to before me this 36 day of on ) -'2 (year) Notary Ptii lc JOCELYN SARK® Notary Public: State of New Y * pISA{ -F22745 (loaltl f, eQ IN pol our� l or(I �Jy 11 u55tj,j tic �tl.rG S .I.i��'�: �0 ... Form CA -97 Signed: Title: Corporate Seal JTNAM COUNTY DEPARTMENT OF HEALTI SION OF ENVIRONMENTAL HEALTH SERVI = --� CONSTRUCTION --PERMITT—OWSEWAGE TREATMENT SYSTEIV. PERMIT # P- 9 -0-3 Located at 'DA;rj bj Zy Subdivision name -1 Subd. Lot # Date Subdivision Approved fdhs Owner /Applicant Name Jam.► t j A r as C i �1ti-k lib ,— To r Village PX-%-1-6 ;LSV t- j Tax Map 363 i Block I Lot -5-3 Renewal Revision Date of Previous Approval i 5 n5 Mailing Address 19 L i vv�J„ i7tz . ; f ear-;L-&C)e- i Pj Zip / -Z–dZ,;3 Amount of Fee Enclosed Building Type tZ. S�cc-r►c i5 Lot Area SJO� No. of Bedrooms d3 Design Flow GPD Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of I ©0® gallon septic tank and 4211 L. • 1� o 2,1 w i Vie. itt3s2 ?Ti wig Other Requirements: To be constructed by ° i o CSC- ►ac�c2rh 4,Jcs-> Address Water Su Public Supply From Address ars Private Supply Drilled by :ZZ� r-> jq- ji-r3,,J6L-> Address - I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards,, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any g repairs Si ned: P.E. 1/ R.A. Date 'L a Address'po ,jA -e-► F,r3G�..1�r. i�,,,, PLL,,C - .4 ®t„D Aoo ; 6 License # +4 �o APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage trea t system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified en onside ed necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe it ppr for discharge of domestic sanitary se age only. By: Title: Date: +, f White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICA 'I01�1 TO CONSTRUCT A WATER WELL . .... please print or type PCHD Permit #— Well Location: Street Address: o illage Tax Grid # %o,x -i F.D#,C) FTieg-A- Map-3�,,Zj Block b Lot(s) 63 Well Owner: Name: ,6*,j 4J,%ME� Address: �i'Ee� l�izv^S S5 bv®rddx �. 06rr= �J, f. ,1. 1'ZSC�3 Use of Well: esidential Public Supply Air /Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought __e!_ gpm # People Served _+_ Est. of Daily Usage 4np gal. Reason for Replace Existing Supply Test/Observation Additional Supply (Drilling %,Aew Supply (new dwelling) Deepen Existing Well Detailed Reason plew -swc L, Peak °' e-e- for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No a� Name of subdivision Lot No. Water Well Contractor: °� ���,zr -,��� Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: C -. Thp g Ode hit-e Proposed well location & sources of contamination to be rov' eet/plan. Date: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED. FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. y revision or alteration of the approved plan requires a new permit. Well to be constructed by a watFwell lle r fied by Putnam County. Date of Issue f Permit Iss t0le ia l: Date of Expiration Title: Permit is Non -Trans itrabte White copy - HD file; Yellow copy- Building Inspector; Pink copy - Owner; Orange copy -Well driller Fortn WP -97 SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN . Associate Commissioner of Health Paul Lynch Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Dear Mr. Lynch: DEPARTMENT 'OF HEALTH 1 Geneva Road, Brewster, New York 10509 ROBERT.I BONDI County Executive ROBERT MORRIS, PE Director of Environmental Health June 5, 2006 Re: Field Inspection — Reilly Construction Danbury Road, (T) Patterson TM # 36.31 -1 -53 The above referenced separate sewage treatment system can be backfilled. There are no open comments at this time. If you have any further questions, please contact me at (845) 278 -6130 ext. 2261. GDR:kly Very truly yours, Gene D. Reed Environmental Health Engineering Aide Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Nursing Services (845) 278 -6558 Fax (845) 278 -6026 WIC (845) 278 -6678 Nursing Home Care Fax (845) 278 -6085 Early Intervention/Preschool(845)278 -6014 Fax(845)278 -6648 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES FINAL SITE INSPECTIONs�� Date: _ Inspected by: Z"y lei° Street Location - Owner �•olv37 Town P19T 0 Permit # TM # 36,51 — / 3 Subdivision Lot .# 1. Sewage System Area a. STS area located as per approved plans ........................... b. Fill section - date of placement 3:1 barrier Lgth. Width . Avg.Dpth c. Natural soil not stripped ................: .. ............................... d. Stone, brush, etc., greater than 15' from STS area.......... . e. 1 00' from water course / wetlands ...... ..............4................ IL Sewage System a. Septic tank size - 1,000 ...:.....1, 250 .......... other, ............... b. * Septietank installed level ................ ............................... c. 10' minimum from foundation .......... ............................... d. Distribution Bog"'Dj( TAR outlets at same elevation-water tested ................. 2. Protected below frost .................. ............................... 3... Minimum 2 ft. Original soil between box & trenches e. Junction Box - properly set .......... ............................... 6. renc es 1. Length required �� Length installed ��� 2. Distance to watercourse measured Ft.. // /... 3. Installed according to plan ................................ 4. Slope of trench acceptable 1/16 - 1/32" /foot ............. S. 10 ft. from property line - 20 ft.- foundations.......... 6. Depth of trench <30 inches from surface .................. 7. Room allowed for expansion, 100°/x ......................... 8. Size of gravel 3/4 - 11/2" diameter clean ....... .. ...... ....: 9. Depth of gravel in trench 12" minimum ................... _ - 10..Pipe end& ca ed :.:::::.:::: :: ::::::: :.::::- _.__�__._:_:..._ g. Pumn or Dose Systems 1. Size of pump chamber ................. ............................... 2. Overflow tank .............................. I ............................. 3. Alarm, visual/ audio ........:........... ..............................: 4. Pump easily accessible, manhole to grade ................. 5. First box baffled .......................... ............................... 6. Cycle witnessed by H.D.estimated flow /cycle........... HL House/Building .�� a. House located per approved plans ... ............................... b. Number of bedrooms ....................... ............................... IV. Well Well located as per approved plans .......:......... ...t b. Distance from STS area measured �Dp ft ........... c. Casing. 18" above grade ................ ............. ................... d. Surface drainage around well acceptable ....................... V. Overall Worlananshiu . a. Boxes properly grouted ........................................ I.......... b. All pipes partially backfilled ........... ............................... c. All pipes flush with inside of box ... ............................... d, Backfill material contains stones <4" diameter .............. e. Curtain drain & standpipes installed according to plan.. f. Curtain drain outfall -protected & dir.to exist watercourse g. Footing drains discharge away from STS area ............... h. Surface water protection adequate ........ :.......................... i. Erosion control provided ................. ............................... Rev. 12/02 s Name. and Title = TYPE OF FACILITY X5'05 r4 � X ? =FINDINGS: ' I�/D d�e�IZ ,/4siiss�/ .' .,X ' S " f _ 1¢ - d . - « Signature andTitle RFPl1RT RFC`FTVFT) - I acknowledge receipts of this report SIGNAT 02/96 p Tif =DEPARTMENT OF HEALTH v �CTI�?ITY: REPORT � s Y` 95 1 d Stater J � � Zip - 'a° v x $ - f,F } O v'c tt� _ . Y a� .q A. 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PUTNAM COUNTY DEPARTMENT OF HFALT)R DIVISION OF ENVIRONMENTAL HEALTH SERVICES ATTENTION JOSEPH GENE QL)F,-ST FOR FINAL INSPECTION For: F-111 All information. must be fully completed prior to any Trenches inspections beirig made. Located: ��u-i Famp (T) (tip 0«'ner/Appliczrllt N'Arne-- TM $6P.51 Block I Lot 55 r7 Subdivision Name: t-1/A Subdivision Lbt 4 A Is syste-ai fill completed? A Date: is system connpiete? %f Fa Date: 1.5 system constructed as per plans? Is well diilltd"�' Date: Is well located as per plans? � Are erosion. control =asures in place? Y 5 [a 002/002 I certify.That the system(s), as listed, at the above premises has been constructed and I h.av6.1n3pected and -ve:rifiecl LI'leir --.ornpletion in accordance with the issued PCHM Construction Permit and approved. plans and the Standards, Rules and Regulations x County Department of He -a I t-'k,.. Date: Certified by: PR RA Design Professional Address f7w-;4An EVn..c!� j..Ou oc. 4:' —Lic.4- 0&-144(c 04S-LjST-a(L- Comments FC'T'7-t 'rI*T\'-Q': eY110i"d11d�L111'1. To: Robert Morris CC: From: Reilly Construction Date: 12/7/2005 Re: Bedroom Count Enclosed please find four copies of blue prints for 30 Danbury Road, Patterson, NY — Tax map 36.31-1-53. They are being submitted for a bedroom count review and stamp. Please call us at 845-278-4059 when they are ready for pick up. If you have any questions, please call me. Sincerely Tom Biglin 1 UTNAM NGINEERING, PLLC. Eng/neers and Architects June 17, 2005 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Steinhardt — SSTS Danbury Road It Town of Patterson TM# 36.31 -1 -53 P/E # 7841 Dear Mr. Morris: In accordance with your letter dated 6/14/05, we have added a note to the plans stating that the proposed house, well and SSTS are to be survey located and staked by a New York State Licensed Surveyor prior to construction. I am enclosing four copies of the revised plans. Please replace the plans submitted on 6/15/05 :with the attached plans (Rey. Date 6/17/05). If you have any questions, please contact me at this office. Sincerely, PUTNAM ENGINEERING, PLLC Richard J. Z RJZ /ea Enclosure tLO5zes) 4 vLD ROUTE 6, BREWSTER, New YORK 10509 • (845) 279 -6789 • Fax (845) 279 -6769 • EMAIL: putnamengineering @susc0m.net L�.,/ /TNmAI _ _... Engineers and Architects June 15, 2005 Robert Morris, P.E. Putnam County Health Department, 1 Geneva Road Brewster, NY 10509 RE: Steinhardt SSTS Danbury Road Town of Patterson TM # 36.31 -1 -53 Dear Mr. Morris, In accordance with our phone conversation on June 14, 2005 I am enclosing four copies of the SSTS Plan for the above referenced project. Please note as requested the existing surrounding septics have been shown and the plans adjusted accordingly. If you should have any questions, please call me at this office. _. Sincerely,— PUTNAM ENGINEERING, PLLC v Richard J. p RJZ /ea 4 Ow ROUTE 6, BREmTER, NEw YORK 10509 0 (845) 279 -6789 o Fax (845) 279 -6769 o EmAic putnamengineering @suscom.net SHERLITA AMLER, MD, MS, FAAP Commissioner of Health LORETTA MOLINARI, RN, MSN Associate Commissioner of Health Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Dear Sir or Madam: DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 June 14, 2005 Re: Proposed SSTS: Steinhardt Danbury Road (T) Patterson, TM # 36.31 -1 -53 ROBERT J. BONDI County Executive Review of plans and other supporting documents submitted at this time relative to the above regarded project has been completed. Comments are offered as follows: 1. The plan is to note that the house, well and SSTS are to be staked be a Licensed Surveyor prior to construction. . . Tfie SST9 to the s"olzth acid b: st is to be located on the plan or a note stating that they are -greater- than 200 feet from the property lines. (TM #'s 36.31 -1 -52, 36.31 -2 -53 & 36.31- 2 -54). Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. RM:kly V ry ly y rs r Robert Morris, P.E. Senior Public Health Engineer Water Supply Section (845) 225 -5186 Fax (845) 225 -5418 Environmental Health (845) 278 -6130 Fax (845) 278 -7921 Nursing Services (845) 278 -6558 WIC (845) 278 -6678 Fax (845) 278 -6085 Early Intervention/Preschool (845) 278 -6014 Fax (845) 278 -6648 26'9" Di 4"O,v< BREAKFAST [;ATM 3 ol x 121111 KITCHEN 10'2'* X 12'11' up VING ROOM DINING JR00M 10" x 12,11" 12'31 X 12111" t: ql- FOYER 1019" x 40'0" A I I t i . , I �N BATH 1 BATH 2 BEDROOM 3 8V X X 1'31/t" X 9-7• 11'4" X 107" 017- 07 J, BEDROOM I BEDROOM 2 12'91' X 16'6• 12'5*ltl X 1310" J OPEN TO FOYER IitlUSE COLTN'Vy rJL'PARl'AfFNT OF lit PLANS APPROVE ,j) r 'OR RLDROOAj COrjW oNty, (73 IIEDRoohTS ALL sunsr , PLANS Al 'I "U TV T o PCDOH r TO TjjrS OUSE I) O p R APPROVAL tv SXG,'VA'I'rjl & Tjj, Q'i IMTF t AND E ZATIDNB OF ALL OB.SEA FWIM NDAES ' ARE COFh71MM WE WILL &FORCE ALL CWYFIM TO PFIOTECT OUR CONSIDEPAM FNIESTFM B DEYaDM T}ESE PLANS AND B,EYATOM 3ILAR HOW-9 RE98i4E9 THE RKiNT TO MAKE MMR CHAMMM IN 006M 9fON9 AS R CtXFt D BY MODULAR CONSMUCTION M6"TN=& BUILDER' SITE LOC.+ t3��Ei�Q�7T 0i)lnu1 Z `@@166 `Z? =Q t`f@ v I SHEET a A -3n 0 ADDRESS: OWN. BY: PW N PROD. ID D: C666 I eao ov. cr — .. 'LAMS AND ARCHITECT'S STAMP VALID ONLY FOR MODULAR :DNSTRUC:T ION BY CHELSEA MODULAR HONES. INC NO M CHELSEA MODULAR HOMM INC. affLSEA MODULAR HONEZ INC. P.O. BOX 1108 ROUTE 9V MARLBORO. KY. 12542 914-236-3311 ?1 r.m.e..... .�. _. -- UTNAM Er, tE ERII PLLC. Engi and Architects May 24, 2005 Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Steinhardt SSTS Danbury Road Town of Patterson TM# 36.31 -1 -53 Dear Mr. Morris: As per your direction I am enclosing a new "Construction Permit For Sewage Treatment System" for the above referenced project. Also enclosed is a certified check in the amount of $200.00 (application fee for revised permit). This should complete our revised submission. Please let me know if you should require any additional information. Sincerely, PUTNAM ENGINEERING, PLLC RJZ /ea Enclosure y.., L05225 4 OLD ROUTE 6, BREwsTER, NEw YoRK 10509 • (845) 279 -6789 • FAX (845) 279 -6769 • EmAx: putnamengineering @suscom.net LJ T GUAM PLLE Englneers and Architects CONSTRUCTION PERMIT NEIGHBOR NOTIFICATION LETTER Date: April 11, 2005 RE: Department of Health Review of Proposed Sewage Treatment System for Property Name: John & James Steinhardt Address: Danbury Road Town: Patterson Tax Map #: 36.31 -1 -53 Dear County of Putnam: Please be advised that an application for a Construction Permit relative to the construction of a sewage system and/or well proposed for the captioned property has been made to the Putnam County Department of Health. Attached please find a copy of the latest site plan. If you have any questions, concerns or information which may bear on the Health Department's review of this application, you may call the Health Department at (845) 278 -6130. Very truly yours, PUTNAM ENGINEERING, PLLC Richard J. Project Engineer Received by: Address: 40 Gleneida Avenue Carmel, NY 10512 Tax Map #: 36.31 -2 -54 4 Oi-D RourE 6, BREWSTER, NEW YORK 10509 e (845) 279 -6789 o Fax (845) 279 -6769 . EmAic putnamengineering @rcn.com LITNAM NEINEERINE PLLE. Engineers and Architects April 25, 2005 Mr. Robert Morris, P.E. Putnam County Health Department 1 Geneva Road Brewster, NY 10509 RE: Steinhardt SSTS Danbury Road Town of Patterson TM 436.31 -1 -53 Dear Mr. Morris: I am enclosing four (4) copies of the SSTS plan for the above referenced project revised with respect to the existing well location on the east side of Danbury Road. The absorption trench layout has also been revised accordingly. Please let me know if you need a new construction permit or if we can just exchange approved plans. Sincerely, PUTNAM ENGINEERING, PLLC AM . fI RJZ /cp (L05181) 4 OLD RouTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • FAX (845) 279 -6769 • EMAIL: putnamengineering @rcn.com 0 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION / N ENVIRONMENTAL HEA ! , . a CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # P -J - 0-5 Located at Dst48ui" R-r*4 Tow;;Nr Village Fiscr1 %7 -Sor3 Subdivision name t� �A Subd. Lot # Date Subdivision Approved L!LA Owner /Applicant Name ,6,! -4 r-,S e6T51ed"k%t n- Mailing Address Tax Map Z&, -Si Block I Lot 53 Renewal Revision Date of Previous Approval 5 e e> s 3 o Zip 12=-'i&'3 Amount of Fee Enclosed Building Type -s a Lot Area I, CS'— No. of Bedrooms ;�5 Design Flow GPD 6c°> Fill Section Only Depth Volume PCHID NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of dovo gallon septic tank and x-•7-9 L -F op Other Requirements: To be constructed by "1—c, 5g� DLr-- Te;24-1team Address Water Supply: Public Supply From Address or: Private Supply Drilled by -ro -E& 0g :T --?-ru rJ So Address I represent that I am wholly and completely responsible for the design and location of the proposed system(s) and that the separate sewage treatmentsystem described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs th Signed: P.E. R. A. Date'✓ Address f 7by-,Jpqn �,.i�;,J ,,�� ?L L4- 4- cis z> License # APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the sewage trea t system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified f en onsi ed necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new pe ' it. pp d for discharge of domestic sanitary s74- e only. By: Title: Date: White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES CONSTRUCTION PERMIT FOR SEWAGE TREATMENT SYSTEM PERMIT # Located at 246otlwv Subdivision name Date Subdivision Approved Subd. Lot # 6;) r Village ,q ?7-15eSaJ Tax Map 9, 31 Block 1 Lot Renewal Revision Owner /Applicant Name JoddCOIJAA445 &6 /l)OA7_ Date of Previous Approval Mailing Address IP A. /AJaJ Q 1a�2, Zip JOB Amount of Fee Enclose pjO© Building Type S1AbZ,6*A&L Lot Area of Bedrooms Design Flow GPD 1049 Fill Section Only Depth Volume PCHD NOTIFICATION IS REQUIRED WHEN FILL IS COMPLETED Separate Sewerage System to consist of J000 gallon septic tank and 4i l- ,ir D, o'�'ulilJr d ln7o/J V2�l�N Other Requirements: To be constructed by TO 0, Address Water Supply: Public Supply From Address or: V`� Private Supply Drilled by °gD 131 DwrAuMidab Address I ro.present that I am wholly and completely responsible for the design and location of the proposed system(s) and that the s_pagate sewage treatment system described above will be constructed as shown on the approved amendment thereto and in accordance with the standards, rules and regulations of the Putnam County Department of Health, and that on completion thereof a "Certificate of Construction Compliance" satisfactory to the Public Health Director will be submitted to the Department, and a written guarantee will be furnished the owner, his successors, heirs or assigns by the builder, that said builder will place in good operating condition any part of said sewage treatment system during the period of two (2) years immediately following the date of the issuance of the approval of the Certificate of Construction Compliance of the original system or any repairs the Signed: v P.E. ✓ R.A. Date 1114110-7 Address / Ally ot.o QCU7F(o License # 04WSfi9 �!. , �ooe -9 APPRO D FOR COST UCTIOI14 This approval expires two years from the date issued unless construction of the sewage trea system has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified w, en c nsidereLnecessary by the Public Health Director. Any revision or alteration of the approved plan requires a new perm' . pprove r discharge of domestic sanitary sewage only. By: Title: Date: 3 White copy - HD File; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Design Professional Form CP -97 .SE'PTIC SUBMISSION FORM TO: �'4SC�� ho;z��S DATE:_ GG �ij PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: '6" 4f �TeirR f- NR z� i Ti-1 36 X31 1 - 53 ENCLOSED, PLEASE FIND: 4 COPIES OF THE SSDS PLAN ® COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION WELL PERMIT APPLICATION �� -►�,� HEALTH DEPARTMENT FEE ($400.00) ® SHORT EAF ® DESIGN DATA FORM LETTER OF AUTHORIZATION ® APPLICATION FOR WASTEWATER TREATMENT (PC -97) ® LETTER OF EXPLANATION REMARKS: COPIES TO: SIGNED: (SepSubForm -2001) 4 OLD RouTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 e FAx (845) 279 -6769 • EMAIL: pufnamengineerrng @rcn.com PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of •64iX *' J/ M6S �JT�iI -s1} ►Zi�i Located at VA�Boiy Tip (D V FkT —EPSa -� Tax Map #.S &,31 Block I Lot 53 Subdivision of t4A Subdivision Lot # tA/� Gentlemen: This letter is to authorize Pi) ,.1RP'm PL -L-C-, , a duly licensed Professional Engineer - or Registered Architect to apply for the required wastewater treatment and /or water supply permit(s) to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and/or water. supply systems in conformity with the provisions of Articlet1:45.,.and /or 147 of the Education Law, the Public Health Law, and the Putnam CounkSan Code. _X_ C ntersigned: P.E R. A., #, A_ �; .Very truly yours, � V' ` Owner of Property) Mailing Address: 4- ou7 RojT Co f5xet_I s i aR- - ~ Staie: LA`( Zip: I ©Sy Telephone: (IIFS ) -wci -I p, c Mailing Address:39 �/Vou �Q. �P" I I"a fe, V11 5 01-t State• ✓� Zip: 2 lQ 3 Telephone: (915400M_ 1 6Z3 LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention /Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 RE: Steinhardt Danbury Road (T) Patterson, TM# 36.31 -1 -53 Reservoir Basin Dear Sir: ROBERT J. BONDI County Executive April 8, 2003 The Putnam County Department of Health (Department) has determined that the above referenced application, including fee, and received by this Depart ment on March 31, 2003 is complete. The Department will notify you by April 30, 2003 of its determination. El The Project has been delegated to the Putnam County Health Department for review pursuant to the guidelines set forth in the Watershed Agreement. ® Joint review with the NYCDEP will commence pursuant to the guidelines set forth in the Watershed Agreement. If the Department fails to notify you within the above referenced time frame, you may notify the - Department of its failure by certified mail, return receipt requested. The notice should be sent to my attention at the above address. This notice must include your name, the location of the project, the office with which you filed the application originally, and a statement that a decision is sought in accordance with section 18 -23 (d) (6) of the NYC Dept. of Environmental Protection Watershed Rules and Regulations. If the Department fails to notify you within 10 days of the receipt of the notice, your application will be deemed complete, subject to standard terms and conditions as set forth in the regulations. Please be advised that projects within the NYC Watershed may also require Department of Environmental Protection review and approval of other aspects of a project, such as stormwater plans or the creation of impervious surfaces, and the project applicant should contact the Department of Letter to: Environmental Protection regarding such activities to see if Department of Environmental Protection review and approval is required. Change of Status has been enclosed. If you have any questions regarding this matter, please call me at (845) 278 -6130 ext. 2166. Very t yours, Robert Morris, PE RM:tn Senior Public Health Engineer enc. 4 BRUCE R. FOLEY Public Health Director Im PROJECT: LORETTA MOLINARI R.N., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road .Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention (845) 278 - 6014 Preschool (845) 278 -6082 Fax (845) 278 - 6648 DEPARTMENT OF ENGINEERING AND DESIGN REVIEW DELEGATION STATUS FOR SUBSURFACE SEWAGE_ TREATMENT_ SYYTPBQGRAlY1_. CHANGE DF STATUS STM1 d AMA1. D i TOWN: C SE K PV DEP LOG#: STATUS HAS BEEN REVISED TO: EI DELEGATED 9JOINT REASON: O iJ Please contact Robert Morris, P.E., Senior Public Health Engineer; as soon as possible if there are any questions about this change of status. (DELSTATUS) LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921. Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Re: Proposed SSTS: Steinhardt Danbury Road (T) Patterson, TM# 36.31 -1 -53 Dear Sir: ROBERT J. BONDI County Executive May 1, 2003 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. Neighbor Notification documentation has not been submitted. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments, this application will be considered further. Very truly yours, Robert Morris, P.E. Senior Public Health Engineer W169 e I'll PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: J �j 5T, /A11iV0r ( 7- %f1? ENCLOSED, PLEASE FIND: ® COPIES OF THE SSDS PLAN ® COPIES OF THE HOUSE PLANS El CONSTRUCTION PERMIT APPLICATION ® WELL PERMIT APPLICATION ® HEALTH DEPARTMENT FEE ($300.00) ® SHORT EAF ® DESIGN DATA FORM ® LETTER OF AUTHORIZATION DATE: 5- ' aoU3 µ; X1,3 ® APPLICATION FOR WASTEWATER TREATMENT (PC -97) LETTER OF EXPLANATION REMARKS: COPIES TO: SIGNED: It 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • FAX (845) 279 -6769 ^ EMAILIputeng@bestweb.net n— CO a Postage L24rHere Er 0018 Er Certified Fee st rk Return Receipt Fee (Endorsement Required) O Restricted Delivery Fee l� (Endorsement Required) Total Poetago 8 Fees S f7l Name (PiVSase Print Cleary) (to be completed -by mailer) p- r. -- 4 YiR-------------------------------------------------- arree . C3 � ORKSHIRE_ ROAD -_ -__ s'nif'�1 tE"ASON, NY 12563 tilt U1 cc ° tr Postage $ ! - M�s0018 CC � Certified Fee 2 Postm PTl Return Receipt Fee O Here r9 (Endorsement Required) 2 Q, IM C3 Restricted Delivery Fee (Endorsement Required) O • KI U • c, J ° 0 Total Postage & Fees $ 03 l M M Name fPfeass Print Clearly) fto be by ^+lkler) -- -- ..... RALPH_8�.F�I,I.EEN.flIlRDICK ------------------------- \ .. O Restricted Delivery Fee ° -5 /h ; -sii6 $TER; NY-1U6U9- - -._ - ` O c m m 7PM4ERSWr* r M Postage $ IT Er Certified Fee Postmark MM M Return Receipt Fee <?j Z r-1 (Endorsement Required) C3 Restricted Delivery Fee I C3 (Endorsement Required) A O O Total Postage 6 Fees $ i 05/ a y matte r.-( !) Name AIL ��N�F�. ? °•-•-°•--•-•--•--••-•--.._..--- street. HP '9i°Y IRE ROAD ----------- ---------- r ._--_--___ Oi'. R' itR00/rlRl ^1►1V'Y•TCL'r1.__.r_ ----- -t Article cunt To: Cr, Postage F• rI Certified Fee M Return Receipt Fee a (Endorsement Required) O \ r3 Restricted Delivery Fee 2 (Endorsement Required) O O Total Postage & Fees M Return Receipt Fee I'T'1 I N.— rpf-- Pr/nr rl : tr- IT- 0 n- 43 r— k F• Er Postage $ ' Ilf! ( j�Q18 m \ Certified Fee 2 Postm M Return Receipt Fee + Here r1 (Endorsement Required) C3 \ .. O Restricted Delivery Fee d K (Endorsement Required) ` O V O Total Postage & Fees $ � 0 .-I- M Name lill�f 1/�nfrJ /t1L1IIN ma- -,ii;4*m °ifMf AY'ROAD .................................... k - ERSOWNY -42563----------------------- --- - - - - -- r°- I cr'ry','§isra k d "d JO 1N3WINUJ30 AINnoo WUNind;3WUN April 25, 2003 Robert Morris, P-E Putnam Co. Health Dept. 4 Geneva Road Brewster, NY 10509 TS Re: John & James Steinhardt. S� Route 311 Patterson, Tlutnam Middle, Braneh Reservoir DEP Log # 12897 (Joint Review) Dear Mr. Morris-.,. NI This letter is to inform yon that the•ew York City Depaximent of Environmental Protection (De partment) has determined that the above-referenced application is complete, In addition, the Department has no objection to the approval of the above - referenced regulated activity. This determination is based on the review of ':' ....... submitted documents including the plan titled "SSTS prepared for John and James Steinhardt", last revised April 3, 2003. The applicant must contact Sissy Pe La Ossa of my staff at (9 14) 773-4416 at least 2 days prior to the start of construction of the SSTS so that a Department representative may inspect and monitor the installation. Sincerely, M arg aret O'Connor, F. Supervisor Engineering Design & Review ZO"d xc: James Covey, P.B., NYSDOR 90: i0, S6 ino UI-VT6: xPJ 9NM33NION3 d3a 3AN UT/VAM NCINEERINC, PLLC. Engineers and Architects SEPTIC SUBMISSION FORM TO: -;�W , J, F� . DATE: PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: • 3 - '�94V3 ram a� ENCLOSED, PLEASE FIND: l� COPIES OF THE SSDS PLAN ❑ COPIES OF THE HOUSE PLANS ❑ CONSTRUCTION PERMIT APPLICATION ❑ WELL PERMIT APPLICATION ❑ HEALTH DEPARTMENT FEE ($300.00) ❑ SHORT EAF ❑ DESIGN DATA FORM ❑ LETTER OF AUTHORIZATION Ll Cl REMARKS: COPIES TO: APPLICATION FOR WASTEWATER TREATMENT (PC -97) LETTER OF EXPLANATION 4 OLD ROUTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • Fax (845) 279 -6769 puteng @bestweb.net LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 - 6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 .Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Re: Proposed SSTS: Stenhardt Danbury Road (T) Patterson, TM# 56.31 -1 -53 Dear Sir: ROBERT J. BONDI County Executive March 31, 2003 Review of plans and other supporting documents submitted at this time relative to the above - regarded project has been completed. Comments are offered as follows: 1. Gene Reed, Environmental Health services noted that these is an existing stream on the property. This stream has not been shown on the plan. The construction of this sewage disposal system may be subject to local wetlands regulations. You should contact local wetlands officials in this regard. Upon receipt of a submission, revised to reflect the above comments., this application will be considered further. Very truly yours, Robert Morris, P.E. Senior Public Health Engineer RM:tn UTNAM NCINEERINC, i°LLC. Englneers and Architects SEPTIC SUBMISSION FORM TO: e6�e4 0WIS , P�- DATE: PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: ��k4e5 cSTL-itj A-W I Q/h)s6je(1 vQ, 7, Pt i'L-)qqiA ENCLOSED, PLEASE FIND: r, ; ;-�r )4�' �5 s 3' � 1... (ue COPIES OF THE SSDS ❑ COPIES OF THE HOUSE PLANS ❑ CONSTRUCTION PERMIT APPLICATION ❑ WELL PERMIT APPLICATION ❑ HEALTH DEPARTMENT FEE ($300.00 ) ❑ SHORT EAF ❑ DESIGN DATA FORM ❑ LETTER OF AUTHORIZATION ❑ APPLICATION FOR WASTEWATER TREATMENT (PC -97) ❑ LETTER OF EXPLANATION REMARKS: wi1� -� COPIES TO: SIGNED: 4 OLD RouTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • FAx (845) 279 -6769 • EMAIL: putenpAbestweb.net LORETTA MOLINARI R.N., M.S.N. Acting Public Health Director Director of Patient Services DEPARTMENT OF HEALTH 1 Geneva Road, Brewster, New York 10509 Environmental Health (845) 278 -.6130 Fax (845) 278 - 7921 Nursing Services (845) 278 - 6558 WIC (845) 278 - 6678 Fax (845) 278 - 6085 Early Intervention/Preschool (845) 278 - 6014 Fax (845) 278 - 6648 Putnam Engineering 4 Old Route 6 Brewster, NY 10509 Dear Sir: ROBERT J. BONDI County Executive March 19, 2003 Re: Proposed Construction Permit: Stenhardt Danbury Road (T) Patterson, TM# 36.31 -1 -53 Review of plans and other materials relative to a construction permit for the above captioned property has been completed by this Department. Based upon such review, and pursuant to the provision of Article III of the Putnam County Sanitary Code, you are hereby advised that the proposed method providing water supply and sewage disposal are considered inadequate as set forth below. Therefore, approval of these plans cannot be granted. 1. The SSTS is proposed on a slope greater than 15 %. It is your legal right to request a waiver of the denial based on item(s) noted above. The denial request must, be submitted in writing after the receipt of this letter. The request must specifically state the waiver being sought. If you have any questions, please call me at (845) 278 -6130 ext. 2166. RM:tn Ve y your PbeMorris, P.E. Senior Public Health Engineer PUTNAM COUNTY DLPA.ItENT OF HEALTH DIVISION OF ENVA" . NTAL HEALTH SERVICES DESIGN DATA SHEET - SUBSURFACE SEWAGE TREATMENT SYSTEM Owner JOW WA-41 PMk/#4P_9r_ Address /e� 42 ff / / w,� r YTt ..(���04 o99 Located at (Street) ,12 Sd PaD Tax Map3k31 Block i Lot 53 (indicate nearest cross street) Municipality !"AT ra?,YoA/ Drainage Basin ZAST gaue/% we-5a✓o1lz SOIL PERCOLATION TEST DATA Date of Pre - soaking //, G- 4��O _..,. Date of Percolation Test IPWIZ 1. Hole No. Run No. Tlme , start'- Stop Elapse Time (PMIn.) De th to Water F Ground Surface � d (Ia es) Start Stop Water Level ]dropp In Ine�tes Percolation Rate 1tilln/Inch ao ire 2 /0.'�7� � So as --- a1 a 15 3 4 Z0,95,_ - ! ; 55 30 74 l 17 5 1 /D:pD— Drab b o7l -- 3 C2 13 4 11"Rb -107,19b so ao 5 1 .. 2 4 ... 5. equal percolation rates are obtained at each NOTES: 1. Tests to be repeatdd ;;;same depth until approximately percolation testIdle. (i:e. s 1 min for 1 -30 min/inch, <_ 2 min for 31 -60 min/inch) All data to be submitted for review. 2. Depth measurements (o be made from top of hole. Fonn DD -97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.5' 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' Indicate level at which groundwater is encountered A1OA1-1::r Indicate level at which nibftl" "'i" "`dbserved 111C�E Indicate level to which water,4ewel-mses after being encountered /WE Deep hole observations .made.y; - ��'$T__c'� �E Date �IV� ®�sllsl Design Prof'essional's Seal 3, _Clf r i Indicate level at which groundwater is encountered A1OA1-1::r Indicate level at which nibftl" "'i" "`dbserved 111C�E Indicate level to which water,4ewel-mses after being encountered /WE Deep hole observations .made.y; - ��'$T__c'� �E Date �IV� ®�sllsl Design Prof'essional's Seal 3, _Clf PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION FOR APPROVAL OF PLANS FOR A WASTEWATER TREATMENT SYSTEM 1. Name and address of applicant: Jokx/ 2. Name of project: J J 3. Locatio T . PA-rrWsoti/ 4. Design Professional: 102111JA 9 5. Address: //P/-P Al2A41rE 1y 6. Drainage Basin: i5AS`7- ?/244Zi11?AWVw 14 10509 7. Type of Project: ✓ Private/Residential Food Service Commercial Apartments Institutional Mobile Home Park Office Building Realty Subdivision Other (specify) 8. Is this project subject to State Environmental Quality Review (SEQR)? Type Status (check one) ........................ ..........................:.... Type I Exempt A/0 Type II Unlisted do 9. Is a Draft Environmental Impact Statement (DEIS) required? ......................... �/o 10. Has DEIS been completed and found acceptable by Lead'Agency? ............... 11. Name of Lead Agency 111A 12. Is this project in an area under the control of local planning, zoning,-or other. officials, ordinances? ......................................................... ............................... 13. If so, have plans been subriiitted -to such authorities? .............. 14. Has preliminary approval been granted by such authorities? Date granted: ,uy 15. Type of Sewage Treatment System 'Discharge ................. surface water ✓groundwater 16. If surface water discharge; what is the stream class designation? .................... W% 17. Waters index number (surface) ..... ..:...:......:.::........:.......::: . ..:............:....:..:::..... .A 18. Is project located near a public water supply system? ....... ...................:........... A14 19. If yes, name .of water. supply . Distance to water supply I itkf 20.' Is project site near a public sewage collection or treatment system? . ................ til0 2.1. Name of sewage system Distance.to sewage system 1AUEk 22. Date test holes observed /!• 12-j9oy a 23.. Name of Health Inspector 6�/F '; ED 24. Project design flow (gallons per day) 25. Is State Pollutant Discharge Elimination System ( SPDES) Permit required ?... 26. Has SPDES Application been submitfed-to local DEC office? .................... N Form PC-'97 2 -27. Is any portion of this project located within a designated Town or State wetland? NO 28. Wetlands ID Number ........................... ... ................... ............................... 1A 29. Is Wetlands Permit required? .............................................. ............................... Jl/ Has application been made to Town or Local DEC office? ............................... 30. Does project require a DEC Stream Disturbance Permit? .. .........................: ...... 1qO 31. Is or was project site used for agricultural activity involving application of pesticides to orchards or, other crops, solid or hazardous waste disposal, landfilling; sludge application or industrial *activity? ............................ Yes/No AJd 32. Is project located within 1,000 feet of existing or abandoned landfill, hazardous waste site, salt stockpile, landfill, sludge disposal site or any other potentially known source of contamination? ............................... Yes/No 'DESCRIBE: 33. Is there a local master plan on file with the Town or Village? .............. ............ 5 E 34. Are community water and/or sewer facilities planned to be developed within 15 years in or adjacent to project site? ................................ ..:.......................:.... A1O 35. Are any sewage treatment areas in excess of 15 % slope? ... .....- . .. ....................... O. 36. Tax Map ID Number .......................... ............................... Mapes 3i Block /Lot Lot 63 37. Approved plans are to be returned to ..... Applicant ✓ Design Professional NOTE:.Afl applications for review and approval of a new SSTS to be located within the NYC Watershed shall be sent to the Department, and need not be sent in duplicate to the DEP, although the project may require DEP approval of the SSTS prior to final approval by the Department. Projects within the watershed may also require DEP review and approval ;of other.aspects ofa project, such as stormwater plans or the creation. of impervious surfaces, and the project applicant should obtain the appropriate forms for such activities from DEP and submit those forms to DEP for review and approval. If the application is signed by a person other than the applicant shown in Item l .,the application must be accompanied by a Fetter of Authorization (Form LA -97). Failure to comply with this provision may be grounds for the rejection of any submission. I hereby affirm, under penalty of perjury, that information provided on this form is true, to the best of my knowledge and belief.. False statements made herein are punishable a Class A misdemeanor pursuant to Section 210.45 of a SIGNATURES & OFFICIAL TITLES. .Z g ..�OI ;adl�'�o Marlin Address: 14.16.4 (2/87) —Text 12 SEAR PROJECT I.D. NUMBER 617..21 k Appendix 'C' State Environmental Quality Review - SHORT. ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I— PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLIC NT /SPONSOR ,� J Sr�A114 nT PvrAJ4t iJ5A1 ial &�i 2. PROJECT NAME J VMn11442611- 3. PROJECT LOCATION: Municipality n r ��JJ County &.40 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map) IV /,OCWOA/ iW1010 0,1 PUA19 5. IS PRRO,PP SED ACTION: �ryeW ❑ Expansion ❑ Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: 6l t411_, o5 L� 7. AMOUNT OF LAND AFFECTED: C f l a6 Initially acres Ultimately acres 8. WIILL,L /PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 1J Yes ❑ No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? LrJ Residentlal ❑ Industrial ❑ Commercial []Agriculture ❑ Park/Fore3VOpen space ❑ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAQ? '� El Yes 2 No If yes, list agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑ Yes LIdNo If yes, list agency name and permlVapproval 12. AS A RESULT O�--F,,��PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION? ❑ Yes t�No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE � tepri Date: Applicant /sponsor name: Signature: o If the action is in the Coastal Area and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES APPLICATION TO CONSTRUCT A WATER WELL ,1 please print or type ,�--1 PCHD Permit # 9J Well Location: Street Address: To illage Tax Grid # 2�it%ft pow 17VSQAI Mapa&, 3i Block I Lot(s)63 Well Owner: Name: *IOJuM Address: '0�1 4F� W.41 R19hW1rog IJ Use of Well: L/ Residential Public Supply Air/Cond/Heat Pump Irrigation 1- primary Business Farm Test/Monitoring Other (specify) 2- secondary Industrial Institutional Standby Amount of Use Yield Sought � gpm # People Served Est. of Daily Usage &gal. Reason for Replace Existing Supply Test/Observation Additional Supply Drilling v/New Supply (new dwelling) Deepen Existing Well Detailed Reason 1Y L11�f /L for Drilling Well Type Drilled Driven Gravel Other Is well site subject to flooding? ................................................. ............................... Yes No Is well located in a realty subdivision? ...................................... ............................... Yes No ✓ Name of subdivision Lot No. Water Well Contractor: TO )R Derr -WmktD Address: Is Public Water Supply available to site? .................................. ............................... Yes No Name of Public Water Supply: Town/Village Distance to property from nearest water main: l ,y/itE Proposed well location & sources of contamination to be provi d separate a sheet/plan. Date: /� / ,aloe& Applicant Signature: PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above, is granted under provisions of Article 10 of the Putnam County Sanitary Code and Subpart 5 -2 of Part 5 of the New York State Sanitary Code and provided that within thirty (30) days of the completion of water well construction, the applicant or their designated representative shall: 1) Pump the well until the water is clear. 2) Disinfect the well in accordance with the requirements of the Putnam County Health Department. 3) Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant and/or well driller shall take appropriate action to assure that any and all water and waste products from such well drilling operations be contained on this property and in such a manner as not to degrade or otherwise contaminate surface or groundwater. APPROVED FOR CONSTRUCTION: This approval expires two years from the date issued unless construction of the well has been completed and inspected by the PCHD and is revocable for cause or may be amended or modified when considered necessary by the Public Health Director. Any revision or alteration of the approved plan requires a new permit. Well to be constructed by a water w iller certified by Putnam County. Date of Issue l 3,/It 5 Permit Issuing Date of Expiration of Title: Permit is Non- Transf crab e White copy - HD file; Yellow copy - Building Inspector; Pink copy - Owner; Orange copy - Well driller Form WP -97 PUTNAM COUNTY DEPARTMENT OF HEALTH . DIVISION OF ENVIRONMENTAL HEALTH SERVICES LETTER OF AUTHORIZATION RE: Property of Located at 24113 V F,47-702SOAI Tax Map # .q6• 3/ Block / Lot -63_ Subdivision of Subdivision Lot # Gentlemen: This letter is to authori ze / � 'rAIWII , a duly licensed Professional Engineer ✓ or Registered Architect to apply for the required wastewater treatment and /or water supply permit(s) to serve the above noted property in accordance with the standards, rules or regulations as promulgated by the Public Health Director of the Putnam County Health Department, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said wastewater treatment and /or water supply systems in conformity with the provisions of Article 145 and /or 147 of the Education Law, the Public Health Law, and the Putnam County Sanitary Code. P.E., R.A., #. Mailing Address: State: Zip: /O Telephone: Very truly yours, Signe , •� b (Owner of Property) Mailing Address: �7�1NST� State: /j, Zip: �10,4"9 Telephone: (6L5),; 79— Rcl �� TO: f P151 . PUTNAM COUNTY HEALTH DEPARTMENT PROJECT: Johltl Ef 4025,5 DATE: /�� �l�y P'4 r T32So�1 96'3j-1-63 ENCLOSED, PLEASE FIND: COPIES OF THE SSDS PLAN COPIES OF THE HOUSE PLANS CONSTRUCTION PERMIT APPLICATION WELL PERMIT APPLICATION HEALTH DEPARTMENT FEE ($300.00) SHORT EAF l� DESIGN DATA FORM LETTER OF AUTHORIZATION APPLICATION FOR WASTEWATER TREATMENT (PC -97) ® LETTER OF EXPLANATION REMARKS: COPIES TO: SIGNED: 4 Oro ROUTE 6, BREWSTER, NEW YORK 10509 • (845) 279 -6789 • Fax (845) 279 -6769 f Em6t: puteng@bestweb.net 10;20/2002 14:23 FAX 845 2796769 PUTVAM EvGINEERING PUT CO HEALTH Q001/001 o� OCT -17 -2002 14:11 FROM :PUTNAM COUNTY DEPART 845 -278 -7921 -.` , ,S0 /2002 14:48 FAX 845 27967fl9 PUINAN ENGIMBRINGt BRUCE R, FOLEY P4110 Realth Atrector TC:92796769 i PUT CO REALTQ I)EFARTMW or, TMALTH I Geneva Road Brewster, New 'York 10509 ATT MON: ❑ ADAM STIEDELING %CEM REED P: 1/1 IA002 /002 LCiltI TA MOLINAR,I. RN., M.SX Randlare Public Health Director Direalar Of Pdtteht S'srvices All information below must beSlilb� completed prior to any scheduling, DA,`.i'M : W— 1b, 2W- ENGINEER OR FIRM: gL�Lm—' �! 1C.t Y[ ✓7s2, , { (,(� . PHONE #: � I REASON: K PERCSX PUMPTEST; ' DEEPS: ra ROADISTREET: �J ' I TOWN: A"l C '►-S TALC MA M, 0 6.3 I I y -r- SUBDIVISION: 19t4ltila LOW: CkA OWNER: J pgvwl 5rg2-1( -.! wky� --�— NYMER C_RIT.ERMA]ME -101= L)aR y AND rT SIN G of Bone =.Q YES t] Proposed SSTS within the drainage basin, ofWest Branch or 8ayda Corner Res M. Cars. 13 Proposed SSTS within 500 feet of a reservoir, reservoir atom or control lake. El Proposed SSTS within zoo feet of a. watercourse or a DEC wetland. 13 Proposed SSTS design flow greater than 1000 gailonslday or SPDM Permit required. 0 Proposed SSTS for it Commerical Project, It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) bored on the response. If you answered y= to any of the questions, NYCDEP must witness the soil testing. Thin DepArtment will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYC13 E;P, If a project has been determined to bet Delegated based on tho above response and them subsequant Information indicates NYCDEP is required to witness the soil testing, it will be the sole responsWity of the design professional to schedule re-witnessing of the soil testing with NYCDEP. VOU COUN TY VaZONLY VATA, r © TIME: i OULUTUT) OCT- 10 -200a THU 14:43 TEL:945- 278 -792i OCT -20 -2002 SUN 14:18 TEL:845-278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. P NAME:PUTNAM COUNTY DEPARTMENT OF P. 1 10/10/2002 14:48 FAX 845 2796769 BRUCE R. FOLEY Public Health Director PUT-NAM ENGINEERING 4 PUT CO HEALTH IM002 /002 LORETTA MOL,INARI. RN., M.S.N. Associate Public Health Director Director of Patient Services DEPARTMENT OF HEALTH I Geneva Road Brewster, New York 10509 QUEST FAR FIELD TESMG ATTENTION: ❑ ADAM STIEBELING X—GENE REED All information below must be f& completed prior to any scheduling. DATE: L� � ENGINEER OR (FIRM: buto (.i - l' rli/�' L� PHONE #: REASON: DEEPS: K PERCS• c�i PUMP TEST: 0 ROAD /STREET: oj-l::� o TOWN:. vtgq T bas d"i TAX MAP #• — SUBDIVISION: 4L iia" (Oc -- LOT #: OWNER: YES NO ❑ ❑ Proposed SSTS within the drainage basin of West Branch or Boyds Corner Reservoirs. o ❑ Proposed SSTS within 500 feet of a reservoir, reservoir stem or control lake. ❑ ❑ Proposed SSTS within 200 feet of a watercourse or a DEC wetland. ❑ ❑ Proposed SSTS design flow greater than 1000 gallons /day or SPDES Permit required. n ❑ Proposed SSTS for a Commerical Project. It is the responsibility of the design professional to provide the above information prior to soil testing. This Department will determine the NYCDEP project status (Joint or Delegated) based on the response. If you answered = to any of the questions, NYCDEP must witness the soil testing. This Department will coordinate a mutually suitable time for field testing with the PCDOH, the Design Professional and NYCDEP. If a project has been determined to be Delegated based on the above response and then subsequent information indicates NYCDEP is required to witness the soil testing, it will be the sole responsibility of the design professional to schedule re- witnessing of the soil testing with NYCDEP. DATE: (MLDTEST) FOR COUNTY USE ONLY TIME: OCT -10 -2002 THU 14:43 TEL :845- 278 -7921 NAME:PUTNAM COUNTY DEPARTMENT OF P. 2 SENDING CONFIRMATION DATE : OCT -17 -2002 THU 14:12 NAME PUTNAM COUNTY DEPARTMENT OF HEALTH TEL 845- 278 -7921 . PHONE : 92796769 PAGES START TIME : OCT -17 14:11 ELAPSED TIME : 00'30" MODE : ECM RESULTS : OK FIRST PAGE OF RECENT DOCUMENT TRANSMITTED... 10 /10 /2002 1e:49 9ei eau :7ee7e9 PVPIAM EyaimmitPIG + PVr 00 tPSt.T9 ®ooeioot W WWCA A POI,EY UWMTA 1d01.01M A,N, Ms.N. ArrsCes NUk hil" Riue.r DEPARTWENT OF HEALTH Ast" 4! Pose.: &n*ft 1 Omura Road Brewster, New Yadr 10509 2EQI?$ ELFOR F XID 130TE AMMON; 0 ADAM STUML40 %,-- R]Mb All Informa don below must be fife completed prior to arq aebedding, pN1g;� ?,Q7L INGEr M OR MM: i I % k, & YLU? +jLU—f— PITONS N —(09 ` RL44ON: DREPSr aC "Max PURIPTESTi 0 ROADISTRRRT: TOW _— �A`C'l k�� f � 7AE MAPN• � � p—— �J �J SIJB MSION• �wskAd%, �y� � LOT#. _— ° OWNER: 'ibN�Qb:� crGlt IESt'et2'T— NVCDP:P Cn71TRT1 aiO1NTJ- 12WAw^1��7M11SING YES NO o o Proposed Mrswlmhh the dralna;o basin of Wert Branch or Boyd. Carver Reservoirs. 0 0 Proposed SSTS wkbia $00 ttat of ■ reservoir, reservoir seam or t'ohrtrA Joke. 0 0 Proposed SSTS withia J00 feet of a watercourse or a DSC wetland 0 0 Proposed SST& design Dow greater than 1000 gagmaa/day or SPDES Permit require& A 0 Proposed SSTS for it Cbmmerinl Project. It b the responsibility of tha design profadonal to provide the above Information prior to "I msdo& This Department win doleradae the NYCDRP project states (Joint or Dolepttedj bad on the rapoafe. If yea answered Jar to nay of the hpratons, NVCDSP meat witness the soil hadn& We Department w01 mordiaate s mutually eottable tuna for tkld nesting with the PmOHe the Daigp Proeaslonal and NYCDEP. i It a project has bees demtmSned to be Debepted based on era above response and that sbbs4unt information iodie.tes NYC WP is requlred to wilaere the son tratht& It wilt be tie ads raponelbWty of the deign pre raderal to athadula ro witnessing of the, sall to ingwbh NYCDZP. vmtcomwrvaaatnr �. IM7b 'tttlg: . exPe E OCT -10 -2002 THU 14:43 TEL164S- 279.7921 NRv:PuTNFM axWy OEP RTMENT OF P. a Rp -0 0 0 > z 0 c: PE m W YOUNG > A M 0 R D Litt A 0 tir rn)G z 0 O 0 r -TER G 0 A33 PL S ILT N L No 4 U) EP RT z > s :13 A, cr O 0 ANU ETON 0 rn PL L RD ol Z W Z w P Or ZURICH L 6 0 H no* 4 Ch 0 TI L m . . . . . ..... -6 6 VER RD D sl A, qO 4z j Iz I of .A MARY LA ?0 PG Ww C-0 ............... Corner. Pond a AN Ex 7 dF r st T 65 of .A MARY LA ?0 PG Ww C-0 ............... Corner. Pond a .;L " �.7 " J. PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES cis DESIGN DATA SHEET -SUBSURFACE SEWAGE TREATMENT SYSTEM qa Owner -5 7,eZAell//97z7- — Address. 't>,4Nj?ug 4 Tz Located at (Street) ",&,e pyTeT--�.yerz6 Tax Map 36,31 Block Lot _5-75 (indicate nearest cross street) Municipality 71,47rc::7zSoAl —Watershed XoV37- SOIL PERCOLATION TEST DATA Date of Pre-soaking 6 eig, Date of Percolation Test ................ ............. ........... ... . ............... .... ........... . . .............. ............ ............. . .......... ................ ......... ..... ... w ...... ... ...... .......... e: X... rod...round;: 0. X.:.:'X.St rol ... ...... . ... at l.tee "es.1 ....................... 3 3 4 :33ZY 17 5 /ef06­1011:14 20 Z3 �_ /0 2 5 3 4 0�1 gv 5 1. 2 3 4 5 NOTES: 1. Tests to be repeated at. same depth until approximately equal percolation rates are obtained at each percolation test hole. (i.e. s I min for 1-30 min/inch, s 2 min for 31-60 min/inch) All data to be submitted for review. 2. Depth measurements to be made from top of hole. Form DD-97 DEPTH G.L. 0.5' 1.0' 1.5' 2.0' 2.5' 3.0' 3.5' 4.0' 4.5' 5.0' 5.51.: 6.0' 6.5' 7.0' 7.5' 8.0' 8.5' 9.0' 9.5' 10.0' TEST PIT DATA DESCRIPTION OF SOILS ENCOUNTERED IN 'T'ES'T' DOLES HOLE NO. .06_ HOLE NO. HOLE NO. q 2 Indicate level at which groundwater is encountered iv,gA, : Indicate level at which mottling is observed ii/,21VA'' Indicate level to which water level rises after being encountered --- Deep hole observations made by: Date ll T ©a. Design Professional Name: _ Address: v �_ Signature: Design Professional's Seal �T-2.� v 4 a I acknowledge receipt "of this report: SIGNATURE: 02/96 Trtle; Rev. PTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF ENVIRONMENTAL HEALTH SERVICES INITIAL INDIVIDUAL /COMMERCUL SITE INSPECTION FORM SECTION A. GENERAL INFORMATION Name of Project County'�� Site Location Building construction begun Extent Is property within NYC Watershed ? ................. F_-_-71f Yes 0 No SECTION R. TOPOGRAPHY (Please check all appropriate boxes) 1. 0 Hilly 0 Rolling 0 Steep slope 0 Gentle slope E] Flat 2. 0 Evidence of wetlands �s; ' Low area subject to flooding 0 Bodies of water Drainage ditches 0 Rock outcrops 3. Property lines or corners evident .............. .............................. .....'... Yes No 4. Do watercourses exist on or adjoin the property? 7'� h .....� .....: ............... " � Yes 0 No 5. Will these affect the design of the sewage system facilities ?.`:'.::.'!� "'r- 0. Yes 0 No e, ('r f.. 6. Do watershed regulations apply in this development ? ....................... Yes 0 No 7 Will extensive grading be necessary? ................. ............................ .... F_� Yes F:71, No 8. Will extensive fill be necessary for SSTS? ......... ............................... 0 Yes E]ETIINo 9. Do filled areas exist within the SSTS area? ........ ............................... F_� Yes �No If yes, what is the condition of the fill? SECTION C. SOIL OBSE VATIONS 10. Appearance of soil: Sand a Gravel Loam 0 Clay Hardpan a Mixture 11. Observed from: F__J Borings F_� Bank cut 0" Backhoe excavations 12. Soil borings /excavations observed by on i / I -e%z 13. Depth to groundwater on ] 14. Depth to mottling on 15. Are test holes representative of primary & reserve areas ...... ............................... 16. Soil percolation tests made by on 17. Soil percolation tests witnessed by on SECTION D (on back) R Form ST- I R 2a H SECTI ®N D. DRAINAGE 18. Will proposed grading materially alter the natural drainage in this or adjacent areas? 0 Yes No 19. Will groundwater or surface drainage require special consideration? ..................... a Yes No 20. Will gullies, ditches, etc., be filled and watercourses be relocated ? ......................... Yes . No SECTION E. REMARKS 21. If a common water supply is proposed; has an inspection been made of the existing or proposed source and facilities? ................................ ............................... F Yes No Inspection data 22. Do adjacent wells and/or sewage systems exist? ..................... ........................ ........ Yes F--]..No 23. Additional comments 24. Site observer /inspector and title Lagm 25. Date(s) of observation(s)inspection(s) 1-7 10 2 TEST PIT PR ®FILES Hole # Lot # Hole # 'Lot # Hole # Lot # Depth to water Depth to water Depth to water Depth to mottling Depth to mottling Depth to mottling Depth to rock/imp. Depth to rock/imp. Depth to rock/imp. G.L. G.L. G.L. 0.5 .0.5 0.5 1.0 1.0 1.0 2.0 2.0 2.0 3.0 3.0 3.0 4.0 4.0 4.0 5.0 5.0 . 5.0 6.0 6.0 6.0 7.0 7.0 7.0 8.0 8.0 8.0 9.0 9.0 9.0 10.0 10.0 10.0 —FAJIi PN F%6361 7fi _ oni rnU I , 46 f _ qv,Y _ _ — uJrJ � is rrnJ ril, a �•+ 45j9F - - — — — — 99_ uJlJy oar f r_ I :t�•t' Y 4,y cevr / 2/ aC111F 1o4H0 OfYdCN \ � � � � k tm•1 /ucn/ rxin Y tt; —FAJIi PN F%6361 7fi _ oni rnU I , 46 f _ qv,Y _ _ — uJrJ � is rrnJ ril, a �•+ 45j9F - - — — — — 99_ uJlJy oar f r_ I ROAD / fur 9 O hry �iu�v M, — — — \ 1Yq ♦ � �.a \ ♦ LQB AG.— 'S0 �f- A iIx � JfJJ 4 w� / 51 5 5 5 xm 3 / o�0 .31 -f -_ 36.39`1.12 LDUIIY LIR - -- rnnu[ 0.08 LIMA — — — IWSRIY LIMC _ a • 2 \ \ o- \ /e »♦ 1 /ute 1 1 \49 \50' 51 i ¢ _ / — — — 33 r, p 52 t; —/JJnr SC_ _ — I /•wJ ,/ 53 /aX Jawi /aroi Vic.• I>(�� � �,� /ax'•_ 27` —= — `JJDJ /r /x_ n. ' JJIJ 1JX � _ IIY.•x /96_39{1 13 P/0 3L3 -1-16 L LEND •-•' .. .....••.••••••, s,iI,JOJ llllD 110 DYrYl0. �lFI6M1f�..._ OCIfLVpp L01 m`MKI1 J® DIHJRIDI .:Ila :• - -. - - -- uuD w- - I4JIE+... �r CrLtWJLD IN, hll[. - —J YIADL Wrllpl0 . 110lrOWi IWlL IInYRII 4,y cevr / 2/ \ � � � � k tm•1 /ucn/ rxin Y 4 n.a / LAKEPORT 1 ( PLACE �• f rl1Ji SZ /� / cool • ` 3 uost 1w I I ruv _ 30 `� 541 s _ O y f cmv I tatx uw 3\ uJn rJlav t p/ I �a ~ 55<Jjr s / 26 � �emn /cnr m � � � _ I � �d �•_' ��,eJ.l �J_ -r— J' — ' � / f 2T � r,nv c� •ah � y Nrt 29 _ — ROAD / fur 9 O hry �iu�v M, — — — \ 1Yq ♦ � �.a \ ♦ LQB AG.— 'S0 �f- A iIx � JfJJ 4 w� / 51 5 5 5 xm 3 / o�0 .31 -f -_ 36.39`1.12 LDUIIY LIR - -- rnnu[ 0.08 LIMA — — — IWSRIY LIMC _ a • 2 \ \ o- \ /e »♦ 1 /ute 1 1 \49 \50' 51 i ¢ _ / — — — 33 r, p 52 t; —/JJnr SC_ _ — I /•wJ ,/ 53 /aX Jawi /aroi Vic.• I>(�� � �,� /ax'•_ 27` —= — `JJDJ /r /x_ n. ' JJIJ 1JX � _ IIY.•x /96_39{1 13 P/0 3L3 -1-16 L LEND •-•' .. .....••.••••••, s,iI,JOJ llllD 110 DYrYl0. �lFI6M1f�..._ OCIfLVpp L01 m`MKI1 J® DIHJRIDI .:Ila :• - -. - - -- uuD w- - I4JIE+... �r CrLtWJLD IN, hll[. - —J YIADL Wrllpl0 . 110lrOWi IWlL IInYRII A5 -13UILT MEA5UREMENT5 ( IN FEET ) 1 2 3 4 5 6 1 S q 10 II 12 13 14 15 16 11 A 15 94 92 91 40 40 90 41 112 131 14b 146 141.5 141.5 14l 146.5 150.5 B 33 91 81.5 54.5 82 50 14 l8 11 121 134 135 131 138 140 142 145